Since his cancer diagnosis last year, Kent Manuel has been seeing an oncologist near his home in Indianapolis regularly. It’s been a rough time: After spinal surgery for paralysis caused by his cancer, he’s regaining the use of his legs with physical therapy, but still uses a wheelchair.
Now, Mr. Manuel said, “I deal with the pain.” His oncologist recommended palliative care, a medical specialty that helps people with serious illnesses cope with suffering and distress and maintain quality of life.
So, in November, Mr. Manuel, 72, a semi-retired accountant, began seeing Dr. Julia Friedman, a palliative care physician. “We talk about what works and what doesn’t,” he said. “He listens to what I have to say. She is very flexible.”
The first two medications he was prescribed to reduce pain had troublesome side effects. On the third try, though, “I think we came up with something that works,” he said. His pain is not completely gone, but it has lessened.
Dr. Friedman, the senior medical director at a cancer care technology company called Thyme Care, works hundreds of miles away in an office in Manhattan. She and Mr. Manuel used a video telemedicine link — an option that barely existed in traditional Medicare before the Covid pandemic, thanks to restrictive federal policies.
Medicare expanded telemedicine coverage effectively in 2020, and the expansion is renewed regularly. All this could have ended on December 31st.
Advocates of telemedicine, also called telehealth, endured a nail-biting few days as Congress considered a continuing resolution to fund the government late last year. The 1,500-page bill included a two-year extension for expanded Medicare coverage for telemedicine.
Republicans had agreed to the resolution, but changed their minds after Elon Musk and Donald Trump condemned it. “That killed the bill,” said Kyle Zebley, senior vice president for public policy at the American Telemedicine Association.
Eventually, Congress approved a narrower version, a three-month extension. So telemedicine lives on, at least until March 31.
Mr. Zebley, who estimates that 20 to 30 percent of medical encounters could actually happen, expects further renewal. Telemedicine is “so popular and so bipartisan in nature that I can’t imagine the Trump administration and Congress will allow it to be repealed,” he said.
Tricia Neuman, who directs the Medicare policy program at KFF, the nonprofit health policy research organization, agreed. “Telehealth coverage appears to be here to stay as an option for Medicare patients,” he said in an email.
Its use has declined since the early pandemic. When patients were afraid to make medical appointments and many practices closed their offices, Medicare began covering video and audio home visits for more types of providers and many more conditions.
Almost immediately, the use of telemedicine skyrocketed. In 2020, nearly half of Medicare beneficiaries had at least one such visit. By the end of last year, that figure had fallen to about 13 percent.
That still represents much higher usage than in early 2020, when about 7 percent of beneficiaries had virtual visits.
Although telehealth works better for some services than others, “some patients have come to rely on it,” Dr. Neuman said.
Get palliative care, which is not widely available everywhere. Indiana, for example, received a not-excellent 2.5-star rating for palliative care capacity in the Center for the Advancement of Palliative Care’s state rating.
Telemedicine can help fill the gap. “By working closely with oncologists who see them in person,” Dr. Friedman said, “we are able to take good care of patients with advanced cancer and have access to them.”
Even if Mr. Manuel had managed to quickly arrange an appointment with a local palliative care doctor, “I’m disabled so traveling is a hassle,” he said.
A short in-person consultation might require two laborious hours to get into a car (driven by a carer), secure a wheelchair and then unload it, enter a medical facility, wait and then reverse the process.
Instead, “it’s really nice to sit in my house and hold a phone in front of my face and just talk,” he said.
Other patients have described a similar hybrid approach. Jim Seegert, 74, a retired graphic designer in Hopewell Junction, New York, sees his primary care doctor in person four times a year to manage his diabetes, high blood pressure and high cholesterol.
“I’m a face-to-face person,” he explained. Plus, he needs blood tests and “there are things that can’t be done on the Internet.”
But to discuss the results, he schedules a virtual visit, usually by phone. “I’m happy to have the option,” he said.
Bruce Lerner estimated he had 10 telehealth visits in 2024. “I had a rough year,” said Mr. Lerner, 67, an attorney in Washington, DC “I had Covid. I had shingles. I had pneumonia.”
Sometimes his clinicians at One Medical, the primary care practice owned by Amazon, told him to come into an office or get a chest X-ray at a radiology clinic.
About half the time, however, they listened, advised and prescribed virtually. “Not only does it reduce unnecessary office visits, but it probably also reduces ER visits,” said Mr. Lerner.
Ellen Epstein, 77, of Lexington, Mass., is tired of driving an hour in traffic to and from Massachusetts General Hospital. Her medical visits piled up in recent years as Ms. Epstein, a writer, was successfully treated for uterine cancer, recovered from a stroke and battled atrial fibrillation.
So when it comes to seeing her primary care doctor, she’s willing to schedule video visits. “Because she’s been my doctor for so long, it’s been a very easy transition,” Ms. Epstein said.
Her husband credits telemedicine with letting him go to the emergency room after a friend’s dog bit his leg. On video, their doctor could see the wounds and decided that home treatment would be enough.
In part, because much of the research on telemedicine took place during the early pandemic, an abnormal period, questions remain about its cost and effectiveness.
An early study of about 200 elderly patients using telemedicine, for example, found general satisfaction. However, nearly 40 percent said it was worse than in-person visits, and some found the technology frustrating.
That may be less true three years later, but “the main barrier is still technology,” Dr. Friedman said. Some providers are now sending links to patients so they don’t have to remember logins and passwords, and are hiring staff to help them log in.
Another early study, using Medicare claims data, reported that telehealth was associated with slightly more hospitalizations and clinician encounters, as well as modestly higher costs per patient. But that could reflect greater hospital capacity in areas with high telehealth use during the pandemic, the authors cautioned, not necessarily lower quality care.
On the other hand, another study also found increased patient visits and costs in health systems with greater use of telemedicine, but no change in hospitalization and lower emergency department use.
More recently, a clinical trial involving patients with advanced lung cancer (mean age: 65) found equivalent satisfaction and quality of life scores between those who received palliative care via video visits and those who received it in person.
“The data is really clouded because we were still looking at data from the public health emergency,” Dr. Friedman said. Now, he added, “we would benefit from more studies of the results.”
Mr. Manuel, for one, has become a believer. He finds telemedicine “incredibly more efficient,” he said, and “broadens the pool of professionals I can consult with.”
“I will choose telemedicine over an in-person visit whenever available.”
